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Improving Heart Failure Care in Minority Communities

Mount Sinai Health System logo

Mount Sinai Health System

Status

Completed

Conditions

Systolic Dysfunction
Congestive Heart Failure (CHF)

Treatments

Behavioral: Nurse-management

Study type

Interventional

Funder types

Other
Other U.S. Federal agency

Identifiers

NCT00211874
GCO 99-0347
AHRQ R01 HS10402-01 (Other Identifier)

Details and patient eligibility

About

For congestive heart failure (CHF) patients with systolic dysfunction, a randomized controlled trial compared nurse-based disease management to address problems in patient and clinician management with usual care for effects on hospitalization and functioning among ethnically-diverse patients in ambulatory practices.

Full description

Congestive heart failure (CHF) disproportionately afflicts Black and elderly people, and is a leading cause of hospitalization > 65 years. Although effective therapies can improve functioning and survival in patients with systolic dysfunction, many may not be receiving the full benefit of existing knowledge, including counseling on self-management and appropriate doses of medications. Patients play a critical role in managing a chronic condition such as CHF, but may not have the skills to do so. Clinicians may not provide counseling or medications consistent with evidence-based guidelines.

Systematic reviews of clinical-behavior change have suggested that interventions targeted to specific problems are more likely to be successful. Based on shortfalls identified in patient self-management and clinical care in Harlem, a predominately non-white area in northern Manhattan, we tailored a nurse-management intervention to address the problems documented, and evaluated its effectiveness in a randomized controlled trial. This trial among primarily-minority patients addresses important gaps in this literature: the study targeted problems documented among CHF patients in Harlem, enrolled patients from ambulatory practices, randomly assigned patients between nurse-management and usual care, and evaluated their subsequent health-related outcomes. Hypothesis: the nurse-management program would result in nurse patients' having fewer hospitalizations and reporting better functioning.

Enrollment

406 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • • adults >18 years,

    • systolic dysfunction documented on a cardiac test (echocardiography, radionuclide ventriculography, myocardial stress sestamibi/thallium testing, or left-heart catheterization),
    • English- or Spanish-speaking,
    • community-dwelling at enrollment, and
    • current patient in a general medicine, geriatrics, or cardiology clinic or office at a participating site.

Exclusion criteria

  • • medical conditions that prevented a patient's interacting with the nurse, including blindness, deafness, and cognitive impairment;

    • medical conditions that required individualized management that might differ from standard protocol, namely pregnancy, renal dialysis, and terminal illness; and
    • procedures that corrected systolic dysfunction, such as heart transplantation.

Trial design

406 participants in 2 patient groups

Nurse-management
Experimental group
Description:
nurse-led intervention focused on specific management problems
Treatment:
Behavioral: Nurse-management
Usual Care
No Intervention group
Description:
Usual care as control group

Trial contacts and locations

4

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Data sourced from clinicaltrials.gov

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